Sasanuma Naoki, Takahashi Keiko, Yanagida Ai, Miyagi Yohei, Yamakawa Seiya, Seo Tetsu, Uchiyama Yuki, Kodama Norihiko, Domen Kazuhisa
Department of Rehabilitation, Hyogo Medical University Hospital, Nishinomiya, Japan.
Department of Patient Safety and Quality Management, School of Medicine, Hyogo Medical University, Nishinomiya, Japan.
Prog Rehabil Med. 2023 Sep 26;8:20230032. doi: 10.2490/prm.20230032. eCollection 2023.
Coronavirus infection 2019 (COVID-19) is an indication for rehabilitation medicine, especially in severe cases. However, there has been no system analysis of safe and continuous provision of medical rehabilitation for COVID-19 patients. The aim of this study was to confirm the effectiveness of rehabilitation for severe COVID-19 and to analyze the optimization of the medical rehabilitation system using the Functional Resonance Analysis Method (FRAM).
The subject of the analysis was the medical rehabilitation system itself, which had been implemented by the Rehabilitation Center of our hospital in response to the increased number of COVID-19 patients. In the FRAM analysis, Functions were identified, and their relationships were examined. Functions were established using a hierarchical cross-check by the authors. Patient outcomes resulting from optimization of the rehabilitation system were length of hospital stay, patient independence in daily living, and rehabilitation-related medical costs, and these were statistically validated.
In repeated optimizations of the rehabilitation system, the main issues were "handling of infected patients and isolation of usual clinical practice," "staff rotation," and "remote consultation". The modification of the medical rehabilitation system was associated with shorter hospital stays, shorter periods of time without prescription, faster improvement in independence of daily living, and lower rehabilitation-related medical costs.
Optimization at each stage of medical rehabilitation resulted in positive effects on patient outcomes. FRAM is useful for identifying and the optimization of key functions.
2019冠状病毒病(COVID-19)是康复医学的一个适应症,尤其是在重症病例中。然而,目前尚无关于为COVID-19患者安全、持续提供医学康复的系统分析。本研究的目的是确认重症COVID-19康复治疗的有效性,并使用功能共振分析方法(FRAM)分析医学康复系统的优化情况。
分析对象是我院康复中心针对COVID-19患者数量增加而实施的医学康复系统本身。在FRAM分析中,识别功能并检查它们之间的关系。功能由作者通过分层交叉核对确定。康复系统优化带来的患者结果包括住院时间、患者日常生活自理能力以及康复相关医疗费用,并对这些结果进行了统计学验证。
在对康复系统的反复优化中,主要问题是“感染患者的处理与常规临床实践的隔离”、“人员轮岗”和“远程会诊”。医学康复系统的改进与缩短住院时间、无医嘱时间缩短、日常生活自理能力更快改善以及康复相关医疗费用降低相关。
医学康复各阶段的优化对患者结果产生了积极影响。FRAM有助于识别和优化关键功能。